Legal And Ethical Aspects Of Resource Distribution In The Emergency Unit

Discuss the legal and the ethical aspects while distributing resources in the emergency unit. 

Factors influencing resource allocation

This paper discusses the legal and the ethical aspects while distributing resources in the emergency unit. Ethics are used to rationalize our deeds, and a dilemma in ethics happens whereby there exists a possibility of two or more results. The professionalism consists of legal principles and ethics which leads patients who require therapeutic services to healthcare providers who put at heart the interest in caring patients. In cases of a conflict involving a health care provider with the patient's view on therapy and the well- being of the patient, legal aspects and ethical principles plays a substantial role in a healthcare system (Durocher, et al., 2017).  The most greatly integrated unit and populous unit in a hospital in the emergency care unit. The high demand for healthcare causes overcrowding in the emergency unit as compared to the distribution of resources such as skilled personnel, economy, time and equipment this is as stated by the Australasian College of Emergency Medicine. The increased demand for healthcare is higher than the available resources indicates the insufficiency of funds in an emergency unit.

Resources available in the emergency unit includes:

• Ambulant services.
• Space for treatment of patients after undergoing triage stage and or critical care.
• Supplies such as equipment needed to identify the condition of a patient, medical accessories and pharmaceutical products.
• The need for staffs because it is a critical care unit. There is a need to ensure the availability of skilled personnel within the group and any time they are required.
• Unique rooms are required for specific instances such as the isolated rooms to treat patients with burns and infectious patients.

Resource allocation is conducted in three levels (Runciman, et al., 2017):

• Micro-level
• Macro-level
• Meso-level

The three levels constitute the society’s multiple stages, involved in resource distribution. Allocation at the macro-level is grounded in sectors such as health, education while at meso-level it is done based on groups, fields and geographical locations.  Individuals at the micro level are engaged in the clinical judgment of accessing resources and healthcare resources. Prioritization over the access benefit towards healthcare services where funds are insufficient must be considered (Watts, et al., 2017).

Prioritization enables fair and proper access to the available resources. Triage is the exercise of employing right decisions in prioritization. This helps in priority assessment depending on clinical urgency or medical condition. Social conditions, traditional and cultural aspects prevailing also have a significant role in explaining the principles of triage. 

Ethics play a crucial role during triage in the emergency care department or when using healthcare resources on a single individual over the other because of the insufficient funds. Additionally, it aids in making decisions in cases of high uncertainties about the treatment effectiveness towards the medical conditions of a patient because a response to treatment differs among the class of people having the same medical condition (Harriss, et al., 2017).

Post triage is where the limited available resources are spent on some patients for the more significant benefit, which happens by sacrificing the necessity or needs of other patients who may not fully utilize them. Therefore, triaging is useful in the proper utilization of resources with full benefits. Although there is possible conflict in undertaking the triaging exercise, that is abandoning a section of individuals for maximum advantage to others. Triage principles occasionally give insight into the policy of utilitarian, that is, an act is right only and when the benefit is maximized (Maiorana & Ntoumanis, 2017).

Resource allocation at the macro, meso, and micro levels

However, the application of the principle of utilitarian has contradictions as it suggests to sacrifice few to maximize the benefits for a more significant number, and a capable outlook is required to help provide the services necessary based on the set health threshold abilities of the individual. The antagonism towards the principle of utilitarian underpins the virtue ethics and deontology (Brotherton, et al., 2017).

Virtue ethics and deontology advocate for the morality of character and actions that is, taking actual responsibility for every individual who requires the services and grants improved care possible not causing any harm. Thus the creation of principles for the addition of various ethical principles is needed. It leads to the application of the law of distributive moral justice. It is mainly concerned with equity, not equality, that is, fair distribution as opposed to equal treatment of all patients applying the necessary approach.

The distributive justice principle can be categorized into the principle of equality, the utility principle and the equality principle (Curtis, et al., 2018).

• The equality principle supports deontology by looking at every person’s as to be equally valuable and the opportunity of getting required care must be equal. Although this kind of triage principle operates by first come first served treatment principle. This may lead to limited use of the available resources whereby taking care of a few or one patient could be a burden.
• The utility principle accommodates the utilitarian principle of arriving at an action or a decision through the analyzation of the outcome of the acts and their capability to attain the most essential benefit among the victims. The principle of triage helps in the maximization of the efficient usage of the resources available. However, this refutes the equality principle that minimizes the efficient use of resources that are limited by equally using them. The primary challenge with the utility principle is ambiguity in upgrading the kind of benefit required for the maximization of the result and the usage of resources in regards to the interest. The benefit could be to increase disability-adjusted or quality-adjusted to save the lives of individuals or life years (Lindstrom, et al., 2017).
• The need principle is based on the prioritizing patients entitled to go through treatment or the worst-off scenarios. It enables prioritization by contemplating the cultural, severity, social and urgency. The urgency in a medical situation doesn’t mean severity, and a severe illness condition does not require to be put under gravity, for example, gangrene as a result of diabetes mellitus. Lastly, the primary approaches are usually at the end of life when urgency and severity are high.  Although when priority is provided to individuals with minimal survival chances, there will be disproportionate use of insufficient resources. This kind of use represents the inefficient use of resources.  Therefore, this principle ought to be rectified in that limited resources would be given to patients with minimal survival chances when treated.

Although the distributive justice system accommodates many ethical principles, it is fragmented with no proper integration to offer improved care from the available resources that are limited.  It requires to be checked frequently for efficient use of resources (Bartkowiak-Théron & Asquith, 2017).

In many circumstances, an individual’s decision-making capacity during an emergency care unit differs since there is a lack of well-set communication between the healthcare professional and the patient. Therefore, the physician’s decision and the patient’s consent is considered essential during care. Additionally, the bioethical considerations play a significant role during the process of decision-making in the healthcare profession as well as helping in the allocation of available resources. Efficiently using the gatekeepers would reduce the use of resources through identification an individual who has to access the healthcare institution (Dwine, et al., 2015). 

All individuals have their rights in taking their own decisions regarding their healthcare. Both the healthcare provider and the patient in trying to obtain as well as providing better care.  However, healthcare providers have the patients’ best interest hence could employ paternal approaches in limiting the autonomy of patients for their well-being. In such situations, the consent of patients plays a significant role in the provision of treatment which would then enable physicians to give protection to the individual personal feelings or any occurring values that decrease paternalism.

The respect to patient autonomy may potentially result in honor of patient choices. The empowerment of patients during the waiting time, the effects of treatment which prevail as well as being available during emergencies may increase the understanding other than helping in accepting the introduced therapy or any other service. Additionally, the autonomy of patients would be respected. Inn autonomy there is an acknowledgment of the decision of patients whether to hold services or make a choice in based on the beliefs and values. On the other hand, in the occurrence of constrained resource condition and emergency, the autonomy of patients is overruled, there is a prioritized societal benefit (Street, et al., 2017).

Prioritization and triage in the emergency care unit

Other than considering the uses of resources, there is a demand for patient autonomy respect due to the restrained existence of resources. Therefore, other stakeholder involvement in the development of guidelines or the principles would help in getting hold of various perspectives different than producing the best available guidelines. Such associations can develop the acceptance of patients in the triaging policies as well as increasing the patient autonomy respect.

In the department of emergency, together with the resources being used efficiently, treatment efficacy would also be considered. In obtaining this, the principle of beneficence that adds to the overall well-being through following the promote or do good policy and non-maleficence which supports Hippocratic oaths in not harm patient treatments using best abilities and knowledge by the healthcare practitioner is involved (Harris & Cooper, 2017). 

By the beneficence principle, professionals in healthcare are bestowed with the responsibility to the society. However, they are not confined the individuals' needs to treat. Regarding this criteria, the healthcare professional is then required to think about the welfare of their society while making use of patient resources. The non-maleficence principle that prevents harming of individuals means the provision of better care without causing harm or injury. Patients who suffer from morbidity go through neglecting during the rule of improved health care for the different healthcare sections that have limited resources. Breaching fidelity causes neglect in that the ethical principle that encompasses fairness, loyalty, dedication, truthfulness as well as patient advocacy. Along with the non-maleficence that results in trust loss on the healthcare profession.

Therefore, the beneficence principle along with the non-maleficence principle get incorporated into the provision of holistic care that encompasses treatment, prevention, and palliative care. This mentioned type of care paves the way for a decrease in the patient influx into the emergency care units. Prevention methods hence contribute to the reduction of the need for future treatment and thus reduce the possible triaging need as well as levels priority. Take the example that frequent education tries maintaining hygiene to minimize the possibility of getting infected with flu or frequent medical check-ups after reaching certain ages thereby decreasing the chances of having cardiac emergencies. Regarding palliative care, that is allocated to patients with unmodified losses and the therapeutic needs approach that reduces morbidity. For example palliative care earmarked to cancer patients. Hence the help in lowering the revisits and relapses to the emergency rooms that ultimately decreases repetitive and excess resources usage (Bryant, et al., 2018).

Ethical principles in resource distribution

By the Victorian health system, there exists a patient right that states the complete healthcare services access with the professional safety and care.

The role of the legal aspect is its importance in the emergency departments during allocation of healthcare resources. The irrationality and illegality in the distribution of resources have not been well established. Some circumstances experience limited resource availability which shows certain provision of holistic care to the individuals at the appropriate time. This is due to triaging that leads to the prioritization of services and resources allocated to patients which can raise legal actions against unfairness and discrimination. The process of triaging id not liable legally unless there is a change in need principle and the individuals having the highest needs lack access to their limited resources.

Healthcare provider negligence is stated by individuals that mainly are unable to provide the best care. This may be due to a decreased care standard or a breach of the care duty which in the long run leads to significant harm/injury evidence that occur due to negligence. In defining injury, one may refer to the physical or personal injury that may be relapsing, psychological or worsening the present medical condition as a result of negligence (Australian Medical Association, 2016).

The healthcare professionals should play their duties in taking care of their patients and have to act in the patients’ best interest. The care duty begins from the start of therapeutic relations. Breaching the care duty occurs when there is harm to the patient caused by the healthcare professional. Reducing the standard of care can lead to damage that could be a result of high levels of risks and harm (Jonsen, et al., 2015).

An addition of waiting times leads to an increase of patient morbidity that is a contradiction of non-maleficence principle that prevents harming off individuals which may potentially affect their psychological condition. Eventually, there may be a resulting act of negligence. In the Under Wrongs Act 1958, section 48, professionals in healthcare should never neglect their patients unless there are set precautions taken to avoid significant risks.

The Northern Australian Law states that healthcare professionals should provide the services or conduct their duties in caring for patients to improve the morbidity by using medical treatments. If not, the act is depicted as guilty and makes one liable for imprisonment for up to seven years under the Criminal Code Act 2014, s155. 

Distributive justice and its principles

In the Human Rights Act 1998, there stated medical resources standard that should be presented to the patient at the time of nee in that everyone has the healthcare accessing right with the responsibility of the health professionals providing the resources. Though there might be the scarcity of resources, the care duty to patients should be provided.

A non-existent necessary skill in staff, as well as the unavailability of resources, lead to individual rights breach where there is limited access to the healthcare services. Therefore, necessary steps have to be taken in preventing such violations that occur due to lack of therapy provided to the limited resources.

Informed consent would reduce significantly play its role in emergency departments. Considering the need for overcrowding and urgency in communication between the healthcare provider and the patient, there is the hindrance. In providing informed consent, there would be the proper understanding of patients regarding better options that are available for therapy. Hence helping in reducing the civil liability in negligence. Additionally, healthcare professionals are supported in following the care duty without breaching (Wilson & Law, 2016).

Conclusion

The legal and ethical considerations are essential developing guidelines for rationalizing resources in the emergency departments. Including various stakeholders allows development of triaging guidelines other than the movement of patients to the sector, hence the adequate resources that can prevent ethical-legal breaching of principles. Healthcare empowerment in professionals concerning ethical-legal tenets as well as the informed patients’ consent helps in honoring the autonomy as well as reducing liability to legality. There should be a note on the conservation of resources in essential resource rationalization. Stewardship of Healthcare resources shows helpful, efficient use and avoidance of misuse of funds. Hence, the proper use leads to the reduction in revisits to the emergency care departments. 

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